This career development award supports the long term goal of Kristen Feemster, MD, MPH, MSHP to be a pediatric infectious diseases specialist and health services researcher who will work to understand how environmental factors, social networks and community systems drive infectious diseases epidemiology in order to inform prevention policies. Her short-term goal is to obtain training and experience in advanced biostatistics and epidemiologic research methods to ensure that she can become a successful independent researcher. The research and training activities described in this proposal provide a foundation for future investigations in community and healthcare epidemiology to build effective policies for infectious diseases prevention. Dr. Feemster's research and learning objectives will be guided by a multidisciplinary team of nationally recognized research mentors and advisors, including Joshua Metlay, MD, PhD (mentor), Susan Coffin, MD, MPH (co-mentor), A. Russell Localio, JD, MPH, PhD (senior biostatistician), Robert Grundmeier, MD (medical bioinformatics) and Louis Bell, MD (health services research). She has constructed a comprehensive program of formal training activities and practical experience through conduct of original research. This award supports the mentoring, advanced training, and protected research time necessary to advance the rigor and quality of Dr. Feemster's work. Dr. Feemster's research plan examines the risk of healthcare-associated influenza-like-illness (HA-ILI) after exposure to a clinic visit. Despite the potential for disease transmission in ambulatory settings, little is known about the epidemiology of ambulatory healthcare-associated infections (HAI). Aim 1 will develop and validate a database for the epidemiologic evaluation of ambulatory HA-ILI using ambulatory electronic health record (EHR) data. Aim 2 will use novel statistical methods to determine if prior exposure to a clinic visit is a risk factor for ILI. Aim 3 will describe and estimate the risk of HA-ILI after an ambulatory care visit. Aim 4 will compare risk adjusted rates across clinics within an integrated pediatric health network to determine if there are specific risk factors associated with variation in HA-ILI risk. Lastly, Aim 5 will identify infection control practices that differ among clinics with low and high rates of HA-ILI. Meeting these objectives will inform future work that evaluates the comparative effectiveness of infection control interventions for pediatric primary care settings. The Children's Hospital of Philadelphia (CHOP) and the University of Pennsylvania (Penn) offer extensive resources and a supportive environment for Dr. Feemster's career development. The Department of Pediatrics and Division of Infectious Diseases at CHOP are committed to ensuring that Dr. Feemster is best positioned to achieve the goals supported by this award.